Provider Demographics
NPI:1821303462
Name:SOUTHWESTERN CON SCH SHELBY CO
Entity Type:Organization
Organization Name:SOUTHWESTERN CON SCH SHELBY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-729-5746
Mailing Address - Street 1:3406 W 600 S
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-9631
Mailing Address - Country:US
Mailing Address - Phone:317-729-5746
Mailing Address - Fax:
Practice Address - Street 1:3406 W 600 S
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-9631
Practice Address - Country:US
Practice Address - Phone:317-729-5746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100472660AMedicaid